Episode 158: Mitral Regurgitation

James from Raleigh called because he was concerned about a heart valve issue:

James: But recently they discovered that I have a bad, real bad leaky valve and the pressure in my heart doesn’t want to work right with my lungs and pushing the blood over to the lungs so they can be re-oxygenated.  They have even come close to even telling me that I might need a heart and lung transplant, but I think they’ve kind of ruled that out.  You know, I’m 64.  It’s liable to kill me.

Dr. Wefald: Let’s do a little bit of background.  So, the mitral valve controls the flow of blood between the lungs and the left heart.  So, when the left heart, which pumps for the body, when it pumps this valve has to close.  Now it’s like a parachute.  It’s not an active closure.  There is a little bit but it captures the blood flowing backwards toward the lungs and then seals the opening so the blood can’t flow back. 

Image result for mitral valve

Sounds like you’ve got mitral regurgitation.  So, when you talk about a leaky valve.  It doesn’t leak outside the heart.  It leaks through that opening so the blood doesn’t flow only in one direction.  It’s supposed to flow out to the body.  When that happens, pressure builds up in the lungs.  You can get what’s called pulmonary hypertension and I think that’s what he’s describing.  And the reason why they are talking about a heart/lung transplant, if it’s possible, is that you have to replace those pulmonary arteries and the only way you can do it is to replace the whole kit and kaboodle. 

Now, let’s talk about this MitraClip.  Before they had to crack your chest, open up your heart, put it on a heart/lung bypass machine and then actually cut out the old valve and put in a new one.  These are made of mechanical components that open and close according to the blood flow and appropriately so.  They also make them out of cow tissue and pig tissue.  Well, somebody said, wait a minute.  The valve is redundant.  It’s floppy.  It doesn’t close because extra tissue allows the blood to flow out.  What if we went up your leg, went into the heart and then clipped those extra bits of tissue together so the valve would be more likely to be closed.  And so, they put two clips in. 

It’s the most amazing thing.  They go up your leg.  They go across the aortic valve, which is the valve that controls the flow of blood out of the heart.  Then under guidance by an ultrasound they find those two clips, I mean those two tissues and clip them together so that no longer does the blood flow backwards much.  It’s captured by a shortened valve so it no longer leaks backwards and it goes forwards.  It’s a great procedure. 

The people who do it at Wake Med are awesome.  Franny Wood is one of them and Bolton, Dr. Bolton is the other one.  They work together and it’s been a great procedure.  Now, at Duke the guy who is involved in the valve stuff is actually someone I was an intern with and he’s a great guy.  Kevin Harrison.  So, it looks like you’ve got some really good doctors ahead of you.  It sounds like you also have something called idiopathic hypertrophic subaortic stenosis.  Is that what they have called it for you?

Caller James: Yeah.

Dr. Frank Wefald: Yeah, so what happens…

Dr. Frank Wefald: Yeah, IHSS.  And when that happens the septum, which is the muscle between the right and the left heart, grows too much and it blocks the flow of blood outside into the aorta and often you can have a leaky mitral valve with this because the mitral valve gets sucked over and actually kisses that enlarged septum.  It sounds like you’ve got some great doctors. 

Listen to the rest of the conversation here.

Heart Health Radio is on 680-WPTF Saturdays at noon. Listen live at WPTF.com, or find the latest episode here.

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